Clinical Pearls

A Review of Colonic Stenting

Emily Goldenthal, DO

When faced with acute colonic obstruction secondary to malignancy, many patients are met with the difficult decision to proceed with emergent surgery. Without rapid intervention, acute colonic obstruction may lead to intestinal ischemia, perforation, sepsis, and ultimately death. Emergency surgery for large bowel obstruction has a high mortality and morbidity rate and is fraught with many long-term complications.^1-2 Moreover, many patients who undergo surgery have incurable disease that may be unresectable and ultimately have a poor prognosis.^2-3

To avoid surgery and the associated high rate of complications, colonic stenting with self-expanding metallic stents (SEMS) may be considered as an alternative, minimally invasive approach to the management of large bowel obstructions.⁴ SEMS are an immediate, nonoperative solution for effective colonic decompression. The use of SEMS started in the 1990s for large bowel obstructions, following the use of similar stents in the biliary, esophageal, and tracheobronchial tracts.^{1, 3}